The Perfect Mother (16 page)

‘I was coming to that,’ she says.

She clears her throat, an abrupt sharp sound, as though she’s making a speech.

‘Tell me, Mrs Lydgate, have you ever heard of Münchausen Syndrome by Proxy?’

‘Kind of.’ Magazines articles skimmed through come back to me. ‘You mean, like Beverley Allitt—that nurse who killed those children?’

She moves her mouth a little, as though she’s trying to smile.

‘Well, it’s nothing like that usually,’ she says. ‘It’s usually in the family.’

‘Like when people poison their children?’

‘There are some terribly disturbed mothers who do behave like that,’ she says. ‘It’s a very strange condition. But there are also mothers who perhaps exaggerate their child’s illness, or do odd things like putting blood in the child’s urine sample—so the children end up having lots of unnecessary investigations.’ She’s straightening
Daisy’s notes between her hands, as though this is important, to have them exactly aligned with the edge of the desk. ‘Sometimes today we call it fabricated illness.’

I shrug. ‘I’ve never heard of fabricated illness,’ I tell her. I don’t know why she’s saying all these things—when time is short and we haven’t started talking about Daisy.

Her throat moves as she swallows. ‘Dr McGuire says that Münchausen Syndrome by Proxy is one diagnosis that he’s considering here.’

For a moment the words don’t make any sense: as though she’s speaking in a different language. A kind of mirthless laughter starts to move through me.

‘This can’t be true.’

She shakes her head. ‘I’m serious, Mrs Lydgate. This is about you and Daisy.’

I’m in a looking-glass world: this is all so crazy, so bizarre. But I feel how my pulse is skittering in my wrist.

‘He thinks I’m like that? He thinks I’m making it up?’

She moves her head; it might be yes or no. The blushing deepens on her throat, the blotches red as paeonies.

‘It’s just one of the things they’re considering,’ she says. She’s looking down at the letter, not meeting my eye.

‘But why on earth would I do that? Why would I make it up, or hurt her, or do any of those things?’

‘I guess he’s got to cover all the bases. He’s got to consider everything,’ she says. She’s careful, cautious, moving a word at a time. ‘When the illness is quite confusing, and the child doesn’t seem to be responding to treatment.’

I lean towards her. ‘But what do you think?’ I’m pleading, trying to reach her. ‘You don’t believe him, do you?’

She hesitates. Some anxiety or uncertainty flickers across her face. I sense the conflict in her, that there’s part of her that wants to stay on my side.

‘He
is
a very respected physician,’ she says, ‘but, to be honest, I do think this is a rather strange suggestion. From everything I’ve read, we tend to find mothers who do these things will be people who’ve had very disturbed childhoods—really quite damaged people.’ She smiles at me, a warm inclusive smile, a smile that says how very undamaged we are, Dr Carey and me: how very undisturbed our childhoods have plainly been. ‘Nothing like what we’re dealing with here.’

I’m worried she will hear the thud of my heart.

‘As you know,’ she goes on, ‘I do think that there may well be a psychological element to Daisy’s illness. But that’s a different thing.’

The nurse in the treatment room next door is saying goodbye to someone. Her voice is vivid, cheerful, it resonates in the corridor. From the waiting room I hear a child shouting. It amazes me that all these ordinary things are still happening.

‘But I don’t understand,’ I tell her. ‘Why do they do it? The women you were talking about, who make their children have all these investigations?’

She considers. ‘It’s thought to be attention-seeking behaviour. For some people, being a mother of a sick child makes them feel needed and admired. As a society,
we tend to view mothers of sick children as rather heroic and special.’

I think of the school gate—Daisy crying; me, frantic and somehow ashamed, peeling her fingers from my wrist like sticking plasters.

‘I don’t feel special,’ I tell her.

She shrugs a little. ‘That’s how it’s generally understood.’

I’m trying to find a way through the maze in my mind.

‘What happens to these women? What happens to their children?’

The blotches are dark on her throat.

‘Well, in extreme cases the children have to be taken into Care. In extreme cases. To be protected from their mothers.’

This is all so stupid, laughable, nothing to do with me. But the inside of my mouth has turned to blotting paper.

She pushes back the cuff of her jacket, and looks at her watch rather pointedly. The consultation is nearly over, and still I haven’t said what I need to say.

‘This isn’t what I came for,’ I tell her. ‘I came to ask to be referred to somebody—you know, a specialist. Someone who will be able to work out what’s wrong.’

She shakes her head a little. ‘I just don’t think that’s how we should go about things,’ she says. ‘I really think that for now we’d do best to go along with what’s been recommended. We don’t want to keep chopping and changing. All he’s asking is for you to see a psychiatrist—just to check some of this out.’

‘But I don’t want to see this psychiatrist—I want to stop all this right now. It’s mad and it won’t help Daisy.’

‘Mrs Lydgate, I don’t think you understand,’ she says. ‘I’m trying to help you here.’ She leans towards me across the desk. Her breath smells of spearmint and her teeth are very white. ‘And my advice would be that you should go along with this. You see, if you don’t co-operate, it’ll only make him more certain he’s onto something. It’s up to you, of course. No one can make you do it, not at this stage. But I really think you should.’

‘What d’you mean—not at this stage? Is there a stage when they
can
make me?’

She ignores this.

‘Listen,’ she says. ‘Just go and see the psychiatrist—and I’m sure this will all blow over. Dr McGuire will have his assessment and that’ll reassure him. And hopefully it will help us find out what’s really going on with Daisy.’

She folds up the letter, pressing on the creases so it’s really neat; she’s going to tuck it back in Daisy’s folder. The consultation is over.

‘Could I see that?’

She hesitates.

I have some vague sense that patients have rights—that there’s a charter or something.

‘I think I have the right to read the letter, don’t I? To see my daughter’s notes?’

She raises an eyebrow: she wasn’t expecting this.

‘Well, yes, you do,’ she says.

It surprises me how readily she acquiesces.

She hands it across to me. I unfold it. There are two pages stapled together.

‘Not here,’ she says. She looks again at her watch. ‘D’you mind? I’m running out of time. Could I ask you to read it in Reception?’

‘Of course.’

‘Just give it to Sheryl at the desk when you’ve finished.’

‘Yes. Thank you.’

I go out to the waiting room, holding the letter with care, as though it could hurt my hand.

There are only two people waiting: a bleary huddled woman, coughing over a copy of
Hello
, and a mother with a baby in a sling. The mother is preoccupied with the baby, pressing her lips to his head. I know how that feels, the sensuous simplicity of it, the tender heat of a baby’s hairless head. I envy her. There are two receptionists: one in a blue cardigan who’s hunting around in the filing cabinet, the other on the phone.

I sit down and reach for a magazine and open it, to shield the letter from view.

It starts with a paragraph about the results of the tests on Daisy. I skim through this, not really understanding.

On the next page the tone of the letter changes.

After I had explained the results to the parents, I broached the possibility that their daughter’s illness might have a psychological cause, and suggested that this possibility should be further investigated. The mother immediately became extremely hostile and aggressive, and adamantly refused to consider
this possibility. This reaction concerned me a great deal, and in view of this concern, I would suggest that Münchausen Syndrome by Proxy or fabricated illness should be part of the differential diagnosis.

This mother does in several respects fit the stereotype that is described in cases of MSBP. She presents, as these mothers usually do, as very nurturing and concerned, and is also somewhat overprotective—for instance, not allowing her daughter to speak for herself, in a way that is quite inappropriate with an eight-year-old child. She is very demanding of medical staff, and appears excessively knowledgeable about and preoccupied with her daughter’s illness—flourishing a sheaf of detailed notes on the girl’s symptoms during the conversation—but has nonetheless failed to comply with the recommended treatment.

In view of these concerns, as well as the shifting and elusive nature of Daisy’s illness, I am referring the family to child psychiatry for an in-depth assessment. In the meantime, I have suggested that Daisy continue with the prescribed medication, though I am not over-optimistic about the mother’s willingness to comply.

Tears start in my eyes.

I glance round the waiting room. The other patients are lost in their worlds, the mother murmuring to the baby, the coughing woman intent on her magazine. One receptionist
has her back turned, the other is still on the phone, talking in her brisk Glaswegian accent, explaining something to somebody down the line, who keeps on interrupting; her head is turned away. I fold the letter and tuck it in my pocket and walk briskly through the door.

CHAPTER 20

H
e comes straight to me where I’m sitting on the sofa, under the masks from Venice. He’s home quite early tonight; it’s his string quartet rehearsal. He kisses the top of my head, then moves a little away. He’s leaning against the window sill, looking at me. Behind him, there’s an operatic sunset, a wash of apricot light, and the new leaves of the birch are precise against the florid sky.

‘What’s the matter?’ he says. ‘Is something wrong? What’s happened?’

I put my glass of wine on the side table, moving slowly, carefully: it could so easily spill.

‘I went to see Dr Carey.’ I can’t breathe; there’s a constriction in my chest. ‘She showed me this letter…She says one of the things they’re considering, to explain Daisy’s illness…it’s called Münchausen by Proxy.’ The awkward words are like solid things in my mouth; it’s hard to spit them out.

He raises an eyebrow.

‘Dr Carey says it’s when mothers make their children’s symptoms worse, or exaggerate them, or invent their children’s illnesses. Like it’s the mother who’s actually causing the illness…’

I put out my hand to pick up my glass but I can’t, my hand is shaking.

His eyes are narrow, watching me.

‘What are we going to do, Richard? Should we make a complaint? D’you know how to do that? D’you think we should do that? Isn’t there a committee or something we could go to?’

‘Darling, hang on a minute,’ he says. ‘Let’s just try and sort this out.’ He’s leaning back against the window sill. He’s dark with the light behind him, his face in shadow; I can’t see his expression. ‘I don’t suppose for a moment we need to do anything drastic. It’s probably just that some medical student’s out to impress the consultant—had this bright idea. Coming up with something really obscure.’

I shake my head. ‘No, it was him—it was Dr McGuire.’

He frowns a little. ‘Anyway, didn’t you say it was just one of the things they were considering?’

‘Yes.’

‘Well, then. Maybe it’s something they always consider with sick children. I mean, they’ve got to be on the alert—there are some very weird people out there.’

‘No,’ I say, ‘it’s not like that. It’s not something they always think of. It’s about me. There’s this letter about me. About how aggressive I am.’

He thinks about this. ‘To be fair to Dr McGuire,’ he says, ‘you did get rather upset. I mean, I’m just trying to see both sides of the picture. I know he was tactless—but you did rather lose your cool.’

‘Anyone would, he was foul.’ There’s a splinter of rage in my voice.

He shrugs, moving his hand a little, as though his point is made.

I was going to show him the letter. It’s there in the hall, in the pocket of my jacket. I had some kind of inchoate notion that he could copy it before we took it back to the surgery, and we could take the copy to show someone. There are surely people who will help you—advisors, advocates, local councillors—people to advise you if you want to make a complaint; there must be—I’m sure I’ve read about these things. All I have to do is to get up and go to the hall and take the letter from my pocket. But my body is slow and heavy, as though my limbs are drenched.

‘What did Dr Carey make of all this?’ he says.

‘She said she thought it was a wrong diagnosis. But she
seemed to think we ought to go along with what he was suggesting, or he’d just be even more convinced he’s right. That’s like blackmail, isn’t it?’

‘Blackmail?’

Why can’t he see?

‘It’s like a trap,’ I tell him. ‘So if you say he’s wrong and won’t do what he wants, it only proves he’s right, so either way you lose.’

‘Darling, you make it sound like some kind of battle,’ he says. ‘I mean, I know you’re very opposed to the psychological approach. But what if there’s something in it? They must have seen so many of these cases. And lots of illnesses are thought to be psychosomatic, aren’t they?’

‘Not Daisy’s illness. It started with flu, for God’s sake. She’s a happy child. I’d know if she wasn’t—I’d just
know
if something was wrong. And look at us. I mean, we’re happy, aren’t we? We’re a happy family…’

He doesn’t instantly reply. There’s a little silence between us. There’s a rushing sound in my ears: the chill movement of air, the windmills turning.

But then he smiles. ‘Of course we are,’ he says. ‘Of course. Well, that goes without saying.’

‘I mean, what am I doing wrong exactly?’ The injustice of it all seizes me. ‘I try to find food she’ll eat, I take her to the doctor, I try to get her to take the medicines but she can’t. I’m always hunting around for people we can go to, people who might help…What’s wrong with that exactly? What do they expect?’